October 01, 2019
The term “evidence-based medicine” has been discussed frequently, but what does it really mean? According to the American Academy of Family Physicians (AAFP), evidence-based medicine is, “the judicious integration of the best available evidence with clinical expertise and an individual patient’s values, preferences and unique circumstances.”
Evidence-based medicine is a popular topic in healthcare because of its many applications. In the shift from fee-for-service to value-based care, evidence-based clinical decisions are utilized to enhance management and reduce unnecessary admissions. Some doctors believe developing more evidence-based guidelines for physicians is a solution to the problem of unnecessary medical treatment. For medical reviews, medical records undergo evidence-based clinical review to make sure services adhere to specific clinical guidelines and regulatory requirements.
Evidence-based medicine is highly pertinent to independent review organizations (IROs). IROs utilize evidence-based reporting in conjunction with clinical research, regulatory requirements and practice guidelines to support their unbiased decision-making. By providing decisions about medical care that are based solely on medical evidence, they act as a reliable and neutral resource with an extensive and specialized knowledge of healthcare services.
The transparency achieved by utilizing evidence-based medicine can help hospitals and health systems improve efficiency and productivity, as well as increase patient satisfaction. Additional benefits include:
Physicians employed by IROs are active in medical practice and stay up-to-date on the latest evidence-based studies and services in their specialty. As noted by the National Association of Independent Review Organizations (NAIRO), they’re required to adhere to evidence-based standards, including:
At MLS Group of Companies, we know applying the best available evidence is necessary for a successful, comprehensive review. That’s why we ensure timely, accurate and evidence-based peer to peer medical reviews from a nationwide network of specialized physician reviewers and healthcare professionals.
Our broad physician network covers all specialties and subspecialties in most jurisdictions. We verify that all questions in the case are appropriately addressed through the use of correct criteria for that specific state or case. Additionally, our quality assurance team reviews all reports to confirm there are no medical inconsistencies or contradictions. We also perform an audit of the physician-provided report to confirm that the entire file was reviewed, the pertinent information was addressed and the decision is conclusive.
Learn more about the evidence-based services MLS provides and the clients we serve to get started on your claims resolutions.
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